Page 174 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP5.4 Healthcare Advances, Research and Innovations 09:00 Room 221

Non-endoscopic Minimally Invasive Thyroidectomy with Minimally Invasive Anaesthesia: Results of a Local
Regional Hospital
Tsui KP, Wong CL, Kwan WYW, Choi CY, Chow TL
Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Hong Kong

Introduction

Thyroidectomy for benign and malignant diseases is traditionally carried out under general anaesthesia (GA) and patients are
admitted post-operatively to surgical ward for overnight observation. In our division, we face a particular problem of limited
GA operative sessions for head and neck operations (one whole-day GA session per week), which is insufficient compared
with the heavy caseloads. With our surgical expertise and utilisation of superficial cervical plexus block, we can perform
thyroidectomy under local anaesthesia (LA) in our LA operative sessions as well.

Objective
To report the results of performing thyroidectomy with a 4cm mini-incision under LA in a local tertiary hospital.

Tuesday, 19 May Methodology

Patients with thyroid nodules sized 4cm or below who opt for operation are recruited if they fit our specific selection criteria.
They are then assessed by nursing staff in Day Surgery Centre for the feasibility of day surgery. From May 2010 to December
2014, 50 patients underwent thyroidectomy under LA using mini-incision in our hospital. Hospital notes were revealed to
record the operative time, amount of blood loss, length of hospital stay and complications. The mean follow-up duration was
15 months.

Results

A total of 50 thyroidectomies were performed of which 41 were benign and nine were malignant pathologies. The mean
nodule size was 2.3 cm. The mean operative time was 75 minutes (range 35 – 124 minutes). The median length of hospital
stay was one day out of which 38 cases were done on a day surgery basis. None required conversion to GA or readmission.
None had complications of wound hematoma or infection. Only one complication, permanent vocal cord palsy (2%), was
recorded. Compared with traditional thyroidectomy, the estimated total costs of inpatient beds saved during the period was
HK$182,000.

Conclusion

Thyroidectomy with a mini-incision under LA is a safe and feasible procedure which is well acceptable to patients. It
facilitates day surgery and saves hospital beds. It also alleviates the long waiting time of GA operation in our unit and permits
better resource utilisation. Collaboration among surgeons, outpatient clinic nursing staff and Day Surgery Centre staff as a
multidisciplinary team are the key to success.

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